‘I knew I'd be taken care of’: Exploring patient experiences in the Emergency Department

Abstract

Aims: To explore adult Emergency Department patient experiences to inform the development of a new Emergency Department patient-reported experience measure. Design: Descriptive, exploratory qualitative study using semi-structured individual interviews with adult Emergency Department patients. Methodology: Participants were recruited across two Emergency Departments in Southeast Queensland, Australia during September and October 2020. Purposive sampling based on maximum variation was used. Participants were recruited during their Emergency Department presentation and interviewed in 2-weeks via telephone. Inductive thematic analysis followed the approach proposed by Braun and Clarke (2012). Results: Thirty participants were interviewed, and four themes were inductively identified: Caring relationships between patients and Emergency Department care providers; Being in the Emergency Department environment; Variations in waiting for care; and Having a companion in the Emergency Department. Caring relationships between patients and Emergency Department care providers included being treated like a person and being cared for, being informed about and included in care, and feeling confident in care providers. Being in the Emergency Department environment included being around other patients, feeling comfortable and having privacy. Variations in waiting for care included expecting a longer wait, waiting throughout the Emergency Department journey and receiving timely care. Having a companion in the Emergency Department included not feeling alone, and observing care providers engage with companions. Conclusion: Patient experiences in the Emergency Department are multifaceted, and themes are not mutually exclusive. These findings demonstrate consistency with the core experiential themes identified in the international literature. Impact: Strategies to improve patient engagement in shared decision-making, and communication between patients and care providers about wait times will be critical to optimizing Emergency Department patient experiences, and person-centred practice. These findings holistically conceptualize patient experiences in the Emergency | 3331 BULL et aL. 1 | INTRODUC TI ON Patient experiences--a description of what happened during a care encounter, and how it happened from the patients' perspective (Bull et al., 2019)--are unique and complex in the Emergency Department. A recent review identified that Emergency Department patient experiences can be broadly described by two interrelated themes: Relationships between Emergency Department patients and care providers, and Spending time in the Emergency Department environment (Bull et al., 2021). Other reviews have similarly demonstrated growing interest in this area by describing the determinants of patient experiences in the Emergency Department including, staff-patient interactions (particularly related to communication and empathic care), wait times, the Emergency Department environment and the emotional impact of experiencing an emergency (Gordon et al., 2010...

Initial Development of a Patient Reported Experience Measure for Older Adults Attending the Emergency Department: Part I—Interviews with Service Users

“…This is also recognised in the literature, for example in a prospective observational study of pain management in the ED by Van Zanden and colleagues [43] where 43.7% of patients arriving in the ED desired pain relief, and the provision of pain relief was associated with higher satisfaction. Pain was also highlighted in a recent qualitative study exploring patients' experiences in an Australian ED [40]. Many patients in this study described pain as a memorable aspect of their ED visit.…”

“…Patients in our study have provided narratives that will contribute to the further development of PREM-ED 65. This study builds on the body of the existing literature emphasising patients' desire to have their basic human needs and comfort addressed during emergency care episodes [25,39,40]. If aiming to optimise patient experience, the provision of humanistic, holistic care should be considered an important caring aspect of the ED alongside the clinical objectives.…”

“…Our interviews suggest that both the length of wait and care delivered whilst waiting for medical assessment and treatment form an important determinant of older adults' experience in the ED. Indeed, waiting is ubiquitously associated with accessing emergency care, and the literature suggests that patients often expect a long ED waiting time [40]. In the UK setting, older patients wait longer, and have a prolonged stay in the ED compared to younger patients [1].…”

Examining the experiences of vulnerably housed patients visiting Kingston, Ontario’s emergency departments: a qualitative analysis

“…Taking the choice away leads to a worse care experience and may increase the risk that they will not return to care when needed [ 27 ]. Research has shown that sharing information about care and involving vulnerably housed patients in treatment decision-making alleviated anxiety, fear, and feelings of isolation in the ED, and demonstrated to patients that healthcare providers are tailoring plans to their individual needs [ 28 ]. One study demonstrated that vulnerably housed patients welcome questions from ED healthcare providers related to housing status and resources [ 29 ].…”

“…Study participants felt that frequent touchpoints from healthcare providers during the visit would significantly improve the experience. Patients also feel ignored, insecure, and frustrated at long wait times [ 28 ]. Frequently they may assume that nothing is being done for them during those times because of bias related to their homeless status.…”